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Biomedical subjects

K R Merikangas

Publications and source records attributed to K R Merikangas.

At least 73 records · Page 4Linked to original sources
PubMed1993

Parental psychopathology and disorders in offspring. A study of relatives of drug abusers.

Associations between psychopathology among parents and among their offspring were examined among families of drug abusers. Patterns of transmission of disorders were examined in the context of several potential moderator variables, including gender of parent, ethnicity, and type of drug abused by the proband relative. The sample consisted of 492 parents and 673 siblings of cocaine abusers, and 400 parents and 476 siblings of opioid addicts. Results indicated that a) maternal depression was associated with several psychiatric disorders among all groups of offspring; b) paternal alcoholism yielded less powerful effects, showing associations with offspring substance abuse among blacks but not Caucasians; c) incidence of disorders among offspring showed sequential increases depending on whether neither, one, or both parents were affected; and d) there was little evidence for specificity of aggregation of disorders among these families. Results are discussed in terms of implications for empirical studies as well as intervention programming.

Adult↗
PubMed1993

Reliability in headache diagnosis.

The reliability of headache diagnosis using the criteria of the International Headache Society (IHS) has not been well studied. One definition of reliability refers to the reproducibility of diagnoses assigned to the same individual at different times. Reproducibility of diagnosis should be assessed using different clinicians at different times, with or without specific diagnostic instruments. A diagnosis may be unreliable because of variability in diagnostic criteria, in the clinical information used to assign diagnoses, or in the interpretation and application of clinical information to a given set of diagnostic criteria. Reliable diagnostic methods are essential to the development of valid diagnostic methods, as well as for the identification of headache risk factors, biological markers, and effective treatments. An approach to studying the reliability of the International Headache Society criteria is outlined, modeled after the extensive studies conducted in the area of psychiatric diagnosis.

Evaluation Studies as Topic↗
PubMed1993

Development of diagnostic criteria for headache syndromes: lessons from psychiatry.

This paper reviews the development of diagnostic criteria for the psychiatric disorders in order to provide a model for the development of classification of headache. The strengths and weaknesses of the current psychiatric classification system, and procedures that have been instituted to strengthen the next version of the classification are described. The problems that characterized the successive versions of the criteria are highlighted in order to stimulate future developments of diagnostic criteria for headache syndromes. Recommendations for application of these principles to headache classification are presented.

Headache↗
PubMed1993

Validation of diagnostic criteria for migraine in the Zürich longitudinal cohort study.

This paper reports the results of a systematic assessment of the validity of the specific diagnostic criteria for migraine without aura, as defined by the International Headache Society (IHS), in a longitudinal epidemiologic sample of young adults who were selected from the general population of Zürich, Switzerland. Systematic modification of each of the IHS criteria for migraine without aura yielded one-year weighted prevalence rates ranging from 24% for the unmodified IHS criteria to 9% for the most restrictive definition of migraine. The major implications of the findings for the IHS criteria are: (a) they provide adequate coverage to classify the majority of subjects with headache in the general population; (b) there is little overlap between migraine and tension-type headache, suggesting that the criteria define moderately independent subgroups; (c) the criteria for migraine without aura appear to be too unrestrictive for application in the community, particularly among young adults at the peak period of incidence of migraine; (d) the criteria for "aura" need more precise operationalization; and (e) models of validation of the diagnostic criteria suggest that Criterion D of the IHS criteria for migraine without aura should be modified to require both gastrointestinal symptoms and photophobia and phonophobia.

Adult↗
PubMed1993

Long-term outcome of panic disorder after short-term imipramine and behavioral group treatment: 2.9-year naturalistic follow-up study.

Twenty-eight patients with a DSM-III diagnosis of agoraphobia with panic attacks who completed a 4-month combined drug and behavioral treatment program and who were then discharged on imipramine were interviewed 1 to 5 years after being discharged. At the time of follow-up, half of the patients were medication free, eight were receiving a lower dose of imipramine, two were receiving the same dose as at the time of discharge, and four patients were receiving other antipanic medications. Panic attack frequency remained reduced at the time of follow-up, as did all anxiety and all impairment ratings. These improvements were similar between patients receiving and not receiving imipramine at this time. Long-term outcome was independent of nonpharmacological therapy during the follow-up interval and lifetime diagnosis of major depression at the time of admission. Our data suggest that improvement observed after 4 months of treatment with imipramine and behavioral therapy is maintained after 1 to 5 years, even for many patients who reduced the dose of or discontinued imipramine. Long-term, randomized studies are needed to compare the efficacy of treatments and to determine treatment duration.

Adult↗
PubMed1992

The Zurich Study. XIV. Epidemiology of seasonal depression.

In a longitudinal cohort study of young adults from the Canton of Zurich in Switzerland (Zurich Study), seasonal patterns of several psychiatric and psychosomatic syndromes were investigated in two interviews over a period of three years. At an age of 27-28 years, 23% of the depressives, 15% of the neurasthenic subjects, and 14% of the subjects with backache reported an increased susceptibility in autumn and/or winter. With respect to the course we found that 10.4% of the subjects of the longitudinal sample (n = 417) suffered from seasonal depression (including individuals with subsyndromal seasonal difficulties) over two consecutive years. Specific symptoms, such as hypersomnia, increase of appetite or weight gain, were not found to be consistently associated with seasonal depression. A comparison of actual and retrospective reports on seasonal depression resulted in a very low reliability. In view of these results the seasonal subtype of depression should be diagnosed with caution, except when the diagnosis is based on longitudinal observations and/or external sources of information (e.g. family members, partner).

Adult↗
PubMed1992

Vulnerability to substance abuse and psychopathology among siblings of opioid abusers.

Vulnerability to drug abuse and psychopathology was explored among siblings of 201 opioid-addicted probands. Disorders were evaluated based on family histories among 476 siblings; a subset of 133 siblings was also directly interviewed. Results indicated that a) siblings of opiate addicts had substantially higher rates of several disorders in comparison with rates in the community; b) as compared with parents of addicts, siblings had elevated rates of substance abuse and antisocial personality; c) the presence of a major psychiatric disorder significantly increased the risk of developing substance abuse among siblings; and d) psychopathology appeared to precede drug abuse in terms of age of onset in this group. Results obtained with the interviewed sample of siblings were replicated in the overall group. Findings of the study are discussed in terms of implications for the classification and treatment of substance abuse.

Adult↗
PubMed1992

A study of twins and stroke.

BACKGROUND AND PURPOSE: Although there are strong genetic contributions to coronary artery disease, only a few studies have considered heritable influences on stroke. METHODS: We investigated the role of genetic factors in stroke using the Twin Registry maintained by the National Academy of Sciences-National Research Council. The registry includes 15,948 male twin pairs born between 1917 and 1927. In 1985, 9,475 twins responded to a mailed questionnaire, which covered vascular risk factors, cardiac events, and stroke. RESULTS: Analysis of twin pairs in which both responded to the questionnaire, and a question on stroke, indicated proband concordance rates of 17.7% for monozygotic pairs and 3.6% for dizygotic pairs (relative risk = 4.3; chi 2 = 4.94, df = 1; p less than 0.05). CONCLUSIONS: This nearly fivefold increase in the prevalence of stroke among the monozygotic compared with the dizygotic twin pairs suggests that genetic factors are involved in the etiology of stroke. The twin study paradigm holds considerable promise for identifying both genetic and environmental influences on stroke.

Cerebrovascular Disorders↗
PubMed1990

Migraine and psychopathology. Results of the Zurich cohort study of young adults.

We present data regarding the association of psychiatric syndromes and migraine headache from a prospective epidemiologic cohort study of 27- and 28-year-olds in Zurich, Switzerland. The prevalence of migraine of 13.3% approximates estimates from previous epidemiologic studies in other regions of the world. Consistent with previous reports, there was a strong association between migraine and depression. However, this is the first study to demonstrate this association in an unselected epidemiologic sample with standardized assessment of psychiatric diagnoses by direct interview. The association between migraine and the anxiety disorders was even stronger than that for the affective disorders. The combination of anxiety disorder and major depression, but not pure anxiety disorders, nor pure depression, were significantly associated with migraine. Our data suggest that migraine with anxiety and depression may constitute a distinct syndrome comprising anxiety, often manifested in early childhood, followed by the occurrence of migraine headaches, and then by discrete episodes of depressive disorder in adulthood. Because of the prospective longitudinal design of this study, future assessments of this cohort will provide further information on the stability of these findings and the course of this cohort as subjects proceed through adulthood.

Adolescent↗
PubMed1990

The genetic epidemiology of alcoholism.

Despite the variability in sampling and methodology, the majority of the family, twin and adoption studies suggest that alcoholism is familial, a significant proportion of which can be attributed to genetic factors. However, the specific components of alcoholism that may be inherited have yet to be identified. To date, there are no biological trait markers for which there is evidence for specificity for alcoholism. The three major levels of enquiry regarding possible mechanisms for the transmission of alcoholism and the involvement of genes and gene products in its development are factors related to exposure, metabolism, or pharmacological effects of ethanol. Exposure to ethanol is an obvious precondition for the development of tolerance and/or dependence. Therefore, identification of factors which enhance (or decrease) exposure are important goals of studies of the pathogenesis of alcoholism. It is likely that demographic, cultural and environmental factors (i.e. sex, age, religious affiliation, social group influences, income, availability of alcohol, etc.) play a crucial role in mediating exposure to alcohol. The key to alcoholism is likely to reside in the effects of alcohol on the brain. In contrast to nicotine, the opioids, and catecholamines, no specific receptor for ethanol has been found. Thus, one major focus of current research on possible central nervous system (CNS) mechanisms for the effect of alcohol includes assessment of the role of alcohol in the stimulation of brain reward or reinforcement systems. Alternately, alcohol may produce dependence by normalizing abnormal baseline states such as irritability, hyperexcitability, dysphoria, impulsiveness, or stress/tension level. The results of animal studies have yielded information on the central effects of alcohol including sensitivity of neuronal membranes, proteins, and ion channels to alcohol, and factors related to the binding and release of neurotransmitters and neuromodulators including dopamine, norepinephrine, gamma aminobutyric acid, pro-opiomelanocortin, glutamate receptors and the endorphin system (Institute of Medicine, 1987). In addition to possible genetic explanations for the strong degree of familial aggregation of alcoholism, alternative explanations need to be further evaluated. These include: modelling of parental behaviour; possible changes in the susceptibility of the foetus to alcohol as a result of in utero maternal ingestion of alcohol; results of negligent rearing manifested in dietary deficiency, exposure to toxic substances, or brain trauma, which so often characterize the homes of alcoholic parents; or damage to paternal germ cells from alcohol.

Adoption↗
PubMed1990

Inverse relationship between defensiveness and lifetime prevalence of psychiatric disorder.

Defensiveness (the tendency not to report unfavorable information about oneself), as measured by the Marlowe-Crowne Social Desirability Scale, has been shown to be inversely correlated with self-reported symptoms. In this family study of depression, direct interviews with 380 subjects combined with relatives' reports revealed a similar inverse relationship between defensiveness and lifetime prevalence of any psychiatric disorder, especially when diagnostic status was most certain and among those at greater risk for psychopathology. The authors conclude that the Marlowe-Crowne scale measures a factor or trait associated with the relative absence of psychiatric disorder, not the underreporting or denial of disorder.

Adult↗
PubMed1990

Comorbidity for alcoholism and depression.

There has been a dramatic increase in attention to comorbidity between psychiatric disorders and substance abuse in both clinical and research settings. Patients with major psychiatric conditions and substance abuse often fall between the cracks in clinical settings because of administrative distinctions between substance abuse and mental health. This article reviews the evidence regarding an association between alcoholism and depression in clinical and epidemiologic studies. Longitudinal and family-genetic studies are also reviewed to address possible mechanisms for the association between alcoholism and depression.

Alcoholism↗
PubMed1989

Linkage studies of bipolar disorder: methodologic and analytic issues. Report of MacArthur Foundation Workshop on Linkage and Clinical Features in Affective Disorders.

To review the findings of the linkage studies of affective disorders, a workshop, "Linkage and Clinical Features in Affective Disorders," was organized by the MacArthur Foundation Mental Health Research Network I on the Psychobiology of Depression meeting in Alexandria, Va, April 13 to 15, 1989. The major goals of the workshop for affective disorders were to explore the relationship between genetic and clinical heterogeneity, to identify major impediments to linkage studies, and to develop recommendations for the application of standardized methods of conducting linkage studies. The participants in the conference presented detailed demographic and clinical data from most of the published linkage studies of affective disorders. No systematic correspondence between genetic and clinical subtypes of bipolar disorder pedigrees was evident. The major problems hampering the linkage analyses of psychiatric disorders that were identified follow: (1) the major psychiatric disorders--the affective disorders in particular--constituting complex human disorders; (2) the lack of valid definitions of affective disorders; (3) comorbidity between the affective disorders with other disorders; (4) nonrandom mating; (5) a cohort effect, with younger birth cohorts exhibiting higher rates of affective disorders; and (6) the lack of replication of current linkage studies. The recommendations that were made for linkage study designs that incorporate some of the complexities of the affective disorders are reported.

Bipolar Disorder↗
PubMed1988

Lifetime prevalence and age of onset of psychiatric disorders: recall 4 years later.

The blind test-retest reliability of lifetime prevalence and age of onset of psychiatric diagnoses, based on the SADS-L interview and RDC over a three-to-five year period, was examined in 143 probands and their relatives. Reliability of lifetime prevalence of major depression was excellent; reliability of antisocial personality, panic disorder, drug abuse, GAD, depressive personality, and alcoholism was good; reliability of obsessive-compulsive disorder and phobia was acceptable but lower. The reliability of hyperthymia or cyclothymia was not acceptable. Reliability for major depression did not vary substantially by age or sex of the informant, but recall of major depression was significantly higher in the probands than in their relatives. The test-retest reliability for the age of onset of major depression and panic disorder was excellent, and for phobia, GAD and alcoholism, was acceptable. Both probands and relatives recalled the age of onset of their depression fairly accurately. However, there was a reduction in agreement over time. Recall after 3-4 yr was better than 5-6 yr. There was a tendency for older respondents to systematically increase the age of onset of their depression across the two interviews, although the increase was only a few years. Recall of age of onset did not differ significantly by sex of respondent or whether the respondent was a proband or relative. These findings are discussed in light of several available studies of reliability of lifetime prevalence of psychiatric diagnoses.

Actuarial Analysis↗